In Depth | Trace, test, seal, repeat: As cases rise, here’s how India is dealing with coronavirus hotspots

The number of coronavirus cases in India has seen a spike over the course of past few days, with as many as 284 of the over 694 districts in the country reporting at least one case of COVID-19 infection.

As of April 10, the number of cases across India has risen to 6,412 with 199 deaths. As many as 1,297 of those cases have come from Maharashtra. The state has recorded the highest amount of cases, and India’s financial capital, Mumbai, has seen a spiraling number of infections.

Most of these cases in Mumbai — and across India — have cropped up in what the government has tended to call hotspots, or places — entire districts, cities, wards or even lanes — which have reported a large amount of infections for various reasons, including aggressive testing and the density of the region.

What are hotspots and how are they identified?

On March 31, Joint Secretary of the Health Ministry, Lav Agarwal had said that hotspots is an emerging concept in India, and one that changes according to the data of the virus spread.

Agarwal had said it isn’t necessary that a hotspot should have a particular number of cases for it to be declared so— even one case suffices, if the authorities feel that there is possibility of wider spread in the area.

The government had on April 6 said while the distribution of the deadly virus in India might be high, it is not an even distribution in terms of the geography, which is why the government’s approach would be different for certain areas for containment where the number of cases is high or where the government feels that they might spike.

In other words, identifying a hotspot and acting quickly to contain the spread of virus.

“A hotspot is an area of elevated disease burden or high level of transmission or small area of 1/2 km with elevated incidence of COVID-19. People may not be family members, therefore, it has the possibility of community transmission,” Dr Jugal Kishore, head of department of community medicine at Safdarjung Hospital told Livemint.

Police enquiring incoming vehicles besides banners on barricades indicating people who are allowed to pass through. (Image credit: Shome Basu)

There might also be an entire city which is considered to be a hotspot by the government, which then is divided into containment zones by the relevant authorities.

For instance, while Mumbai is considered to be a hotspot, the city’s civic body said it has identified over 300 containment zones within the city, which they have proceeded to seal off.

What happens when an area is declared a hotspot?

Late on April 7 night, the Delhi government announced 20 areas in the national capital which they termed as hotspots and said they would be sealed off.

“No person will be permitted inside these localities or will be allowed to leave them,” Delhi’s Deputy Chief Minister Manish Sisodia said. Something similar has been happening in Mumbai, where the areas identified as hotspots are sealed off by the Brihanmumbai Municipal Corporation (BMC) and a board announcing the measure is put up by the civic body officials.

The police and the officials then consistently announce that the area is out of bounds, and essential commodities are provided by the authorities.

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A civic body official said they are also looking into releasing a daily update of areas that are sealed off ward-wise on social media platforms to quell rumours.

In Delhi, which released the list of areas which have been sealed by the authorities, the government said it will ensure the delivery of essential commodities to these regions.

Which areas have been identified as hotspots in India?

The number of areas tagged as ‘hotspots’ has been increasing consistently since the start of April. While the government had said that it has identified 22 hotspots across the country, it had also stated that to take measures in the emerging centers and contain the spread of the disease will require more human resources, which is an uphill task.

Some states, such as West Bengal, have formed a ‘Covid-19 Data analysis cell’ to identify hotspots and advise government on “pre-empting and improving disease surveillance in overall terms”.

Municipal workers distribute bags of food amongst the residents as they maintain safe distance during a 21-day nationwide lockdown to limit the spreading of coronavirus disease (COVID-19), in Ahmedabad, India, March 29, 2020. REUTERS/Amit Dave - RC2OTF94EPER

Municipal workers distribute bags of food amongst the residents as they maintain safe distance during a 21-day nationwide lockdown to limit the spreading of coronavirus disease (COVID-19) in Ahmedabad. (Image: Reuters)

In some states, however, like Maharashtra and Uttar Pradesh, the hotspots have emerged as cases in one particular locality— G-South ward in Mumbai and Gautam Buddha Nagar in Noida, for instance— have seen a consistent rise.

Here’s a list of the major hotspots that have emerged in India over the past few weeks:

Nizamuddin Dargah area, Delhi

The Delhi government has now sealed off 20 hotspots across the city, but initially there were two major ones: the Nizamuddin area and Dilshad Garden.

Housing the shrine of the 14th Century Sufi mystic Khwaja Nizamuddin Auliya, the Nizamuddin locality, which falls in South Delhi, has become an epicenter of the virus not just in Delhi but across India, with attendees of the Tablighi Jamaat congregation going back to different states across India after the event ended on March 15.

Coronavirus spread at Nizamuddin: Here is what central, state govts have done so far

According to reports, around 4,000 people had attended the religious event. Reports suggest that out of the positive cases in India, nearly a third are related to the religious gathering.

When it emerged, on March 22, that the people returning to their states after attending the gathering have been testing positive for the virus, the Markaz, or the headquarters of the Muslim missionary movement were shut with about 2,500 people inside.

Representative Image

“Our doubling rate is 4.1 days at present. But if additional cases reported due to the Tablighi Jamaat had not happened, then the doubling rate would have been 7.4 days,” Agarwal had said during one of the government’s daily press briefings.

The 2,500 odd people were then evacuated, with those with symptoms sent to hospitals and the others to quarantine facilities.

At Dilshad Garden in northeast Delhi, meanwhile, a woman who returned from Saudi Arabia tested positive for the virus, and she in turn came in contact with a mohalla clinic doctor who also tested positive.

This gave rise to fears that there could be a significant spike in the area considering that the doctor had come in contact with hundreds of people.

G-South ward, Mumbai

The G-South ward consists of the Worli-Prabhadevi area. Much like the entire city, the 10-square kilometer region encompasses several stratas of the society: there are high-end office buildings in Prabhadevi from the windows of which one can look over the chawls and slums spread out below them in areas like Worli and Lower Parel.

At this point, however, the area has become the city’s largest COVID-19 hotspot. According to the BMC, the spike in cases can actually be traced back to about 11 initial cases, which had then gone on to spread the infection.

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According to a report by Mumbai Mirror, the civic body has identified 17 locations across the ward as containment zones, and the BMC has surveyed 14,000 homes and over 40,000 people.

State authorities have said that the number of cases not just in this particular ward but across the state have increased because of the aggressive contact-tracing and testing being carried out by the government.

As on April 8, according to the BMC, 184 positive cases have been reported from the ward.

Image: BMC

Worli MLA and state Environment minister Aaditya Thackeray has said that the reason the cases in the ward have been high is because of the constant contact tracing, which is then followed by isolation to contain the spread.

The other area that authorities are concerned about is Dharavi, known to be Asia’s largest slum. The total cases reported in the region stand at 22

Authorities have been conducting health camps in the slum, and have ordered closure of fruits and vegetable markets in the the area.

Follow our LIVE Updates here.

Gautam Budh Nagar, Noida

Uttar Pradesh government on April 8 decided to seal hotspots in 15 districts of the state, including at Gautam Budh Nagar, an area in the National Capital Region’s Noida.

Gautam Budh Nagar had hit the headlines after over three dozen cases were reported from the district, making it the region with highest number of cases in the state.

Of these cases, about two dozen were linked directly or indirectly to a private firm in Noida which was booked for endangering people’s lives and sealed. The number of cases in the district has risen to 63 now, with the overall Uttar Pradesh tally rising to 410.

Representative Image

After the number of cases in the district saw a spike, reports had suggested that UP Chief Minister Yogi Adityanath had pulled up the District Magistrate, BN Singh, for ineffciency in managing the spread of the infection in the district.

According to reports, soon after his meeting with Adityanath, Singh had asked for a three-month leave, after which he was transferred to the Board of Revenue and authorities said that a departmental inquiry has also been initiated against him.

With the district still reporting the highest number of cases in Uttar Pradesh, authorities in Gautam Budh Nagar have reportedly started mobile sample collection from the hotspots. Process for the setting up of testing labs at the Government Institute of Medical Sciences in Greater Noida has also been started.

Bhilwara, Rajasthan

Around mid-March, like most other places in India, Bhilwara district in Rajasthan did not have a single coronavirus case. By the end of that month, however, the textile town had already registered about 26 and things were not looking good.

Reports have suggested that infection in the district began to spread after a doctor at a private hospital tested positive for coronavirus. Most of the cases reported after that were either of the hospital staff or the patients who had gone for treatment at the hospital.

That was March 30. What followed has been called the ‘Bhilwara model’ of containment, with the district showing a rapid turnaround and reporting just one case from the region since.

The containment model worked in several phases, including quick isolation of the district; mapping out the containment zones and setting up a screening strategy in both rural and urban pockets and appointing ‘corona fighters’ and ‘corona captains’ for monitoring activities.

The strategy has been a success, with praise coming from Rajasthan Chief Minister Ashok Gehlot and India’s Cabinet Secretary Rajeev Gauba.

Kasaragod, Kerala 

The district in northern Kerala has reported the highest number of COVID-19 cases in the state, with more than 150 cases being reported from the region.

Much like the other hotspots in India, rapid spread of infection within the district was attributed by authorities to contact with infected persons, but an additional factor in the district was the heavy load of foreign returnees, who were also seen as the cause of the virus spread.

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What made things worse was one particular case of a Gulf-returnee who reportedly met over 3,000 people after his return to Kerala, including two legislators in the area. Reports suggest that the authorities initially struggled to trace his contacts, but the border district was put under a curfew and even essential services were home delivered.

Now officials claim that things have improved. “We have made the turnaround. We did it ruthlessly and told people it is life and death situation. Results are there to see,”  Vijay Sakhare, Inspector General of Police (Kochi range told Hindustan Times.

Indore, Madhya Pradesh

Ranked last year as the cleanest city in India, Indore has now turned into the coronavirus infection hotspot in Madhya Pradesh, and is under curfew for almost a fortnight now.

Indore has so far recorded as many as 173 COVID-19 cases and 16 deaths resulting from the contagion.

The local administration is facing criticism over its strategy in dealing with the pandemic in the initial stages.

“In the beginning the health department focused on screening those who arrived in Indore via Maharashtra, Rajasthan and Gujarat after returning from abroad,” Amulya Nidhi, an activist in health sector, told news agency PTI.

“This was a major error of judgment as Indore is a commercial city and thousands of people arrive and leave through railway and road. But such visitors were not screened initially,” he said.

The district administration announced lockdown in the city from March 23. After the first coronavirus cases were reported in the city, it imposed a total curfew in the city.

“There is no community transmission-like situation (where the person or the event which could be the source of infection can not be ascertained) in the city. Majority of coronavirus cases are coming from a few particular pockets of the city,” Salil Sakalle, head of the medicine department of the government-run Mahatma Gandhi Memorial Medical College told the news agency.

An official said the local administration has made arrangements for home delivery of essential items such as milk, groceries, potatoes and onions so that people need not step out.

Follow our full coverage of the coronavirus pandemic here.

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Updated: April 10, 2020 — 12:48 pm

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